Individual
JACOB DALE MASTERS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
2706 FLOWERSTONE DR, DAYTON, OH 45449-3217
(937) 422-8598
Mailing address
2706 FLOWERSTONE DR, WEST CARROLLTON, OH 45449-3217
(937) 422-8598
Taxonomy
Speciality
Code
Description
License number
State
174200000X
Meals Provider
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0317945
—
OH
Enumeration date
02/28/2019
Last updated
02/28/2019
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